Too Many Students Face Restraint, Seclusion

SARAH EAGAN | OP-EDThe Hartford Courant

A 6-year-old was confined in seclusion in his elementary school, a high school student was held face down in a parking lot by a number of adults and another child, placed in seclusion, was told to use a bed pan to urinate.

Over the last three months, the Office of the Child Advocate received a number of reports like these on the use of restraints and seclusion in our schools, particularly on children with disabilities.

We were told of seclusion rooms that have scratches on the door from children who were placed inside. We were sent pictures of seclusion rooms with concrete walls, metal doors and small, square windows up high.

According to a February report from the state Department of Education, children with disabilities were restrained or placed in seclusion rooms more than 33,000 times in the last school year. The majority of these children were in elementary school. Shockingly, almost 400 of these cases occurred in preschool. These children are mostly boys, often children of color and many of them are on the autism spectrum.

The numbers are likely higher. Some districts report little or nothing to the education department, including the Hartford Public Schools.

More than 6,000 occurrences of restraint or seclusion lasted more than 20 minutes, and 1,000 incidents lasted over an hour. Forty children were restrained or secluded more than 100 times in a single school year.

Although there may be times when holding children is the only way to protect them from harming themselves or others, there is growing evidence that these practices are counter-productive and traumatic, rather than therapeutic or effective behavior intervention. A 2009 Government Accountability Office Report to Congress documented numerous cases of abuse and death related to the use of seclusion and restraint on schoolchildren during the past two decades.

The law does not count brief holds to calm or comfort a struggling child as a "restraint." Nor is a "time out" considered "seclusion," which is legally defined as confinement of children a separate room.

Significantly, federal health care law prohibits the use of standing orders for restraint or seclusion in treating children. Accordingly, in Connecticut, the departments of Children and Families, Mental Health and Addiction Services and Developmental Disabilities all have methods to prevent use of restraint and seclusion. These agencies work with children or young adults who may have profound cognitive, psychiatric or neurologic challenges.

Unfortunately, federal health care law does not govern schools. Connecticut schools are permitted to have standing orders for seclusion of children. Seclusion is a blunt, potentially traumatizing and ineffective tool for children who need individualized and expert educational planning. The only explanation for the tens of thousands of incidents reported in Connecticut schools is that restraint and seclusion are systematically used in behavior modification.

Seclusion and restraint of children is a public health challenge. We must bridge the gap between children's health care and their education. Schools must have the resources and expertise to educate children with complex challenges. Many schools do not even have a social worker on staff, much less a behaviorist, neuropsychologist or developmental specialist. We cannot talk about access to children's mental health care without addressing the need for schools to be more effectively connected to community systems of care.

The U.S. departments of Health and Human Services and Education have heralded positive behavioral support programs and the Six Core Strategies as effective in improving treatment or school climates, addressing problem behaviors in schools, and reducing unnecessary restraint and seclusion. Some Connecticut programs are making great strides with these models.

We should require evidence-based interventions in our schools, not just for literacy development, but for social-emotional and behavioral well-being. We must require meaningful training, transparency of school practices and mandated debriefing for children who are subject to repeated restraint or seclusion.

Children have the right to effective education provided in the least restrictive manner. Parents have the right to send their children to school without fear that their child — already vulnerable in the world, potentially limited in communication or even non-verbal — will be locked in a room, particularly when there is nothing to suggest that this works. And teachers have the right to do their work in a supported environment, free from injuries often caused by forced escort or restraint.

No child, much less a child with a significant disability, should be permitted to be restrained or secluded more than 100 times in a school year.